Culture and Global Mental Health

Mental illness knows no boundaries, a fact that some psychiatry residency programs are incorporating into their training.

“Global mental health is mental health anywhere but here,” said James Griffith, M.D., chair of psychiatry at George Washington (GW) University, with perhaps a touch of irony, given that his residents can begin their “global” clinical work in the next county.

Global mental health has its roots in three overlapping domains, said Griffith—cultural anthropology, acute disaster, and postconflict response, and a public health tradition of alleviating suffering in a world where resources can be scarce. Programs typically combine local work with immigrants with several months overseas, usually in the fourth year of residency.

Just how many residency programs include such components is unclear.

“My impression is that the majority of training programs don’t have a global mental health component, but I think there is increasing interest,” said Christopher Varley, M.D., a professor of psychiatry and behavioral health at the University of Washington and president of the American Association of Directors of Psychiatric Residency Training.

A survey of 171 residency training directors (which received just 59 responses) published in 2011 found that they “endorsed the value of international experiences during residency, but their availability and educational impact are not fully supported.”

So GW and a few other programs appear to be unusual in their embrace of global mental health. Several factors may complicate their establishment. For instance, how will programs cover the cost of an overseas placement or make up clinical coverage or research time for a resident who may be away for months at a time?

Nevertheless, there may well be increasing interest in the concept, said Giuseppe Raviola, M.D., an assistant professor of psychiatry and of global health and social medicine at Harvard Medical School and director of mental health programs for Partners in Health.

“More medical students today are interested in global health, including those going into psychiatry,” said Raviola in an interview. “So psychiatry residency programs will need to offer global mental health options to attract the best new residents.”

“I think global mental health reflects an understanding that in addition to serving communities locally, one way we can do more good is to look beyond our borders,” said PGY-4 Michael Morse, M.D., a 2014-2015 APA American Psychiatric Leadership Fellow.

“Global mental health is not something you tack onto a residency training program,” said Morse in an interview. “Rather, it’s like any other competency in residency, where you need to do it and do it a lot and have mentors and supervisors who can help you learn from their experience.”

Within the GW program, all residents take a 12-week seminar in global mental health in their second year. PGY-3s who select the global track then spend several hours a week at Northern Virginia Family Services, an independent agency across the Potomac River in Fairfax County.

“We think you don’t learn this by going to other countries,” said Griffith. “You train residents and work with immigrant and refugee populations here, develop the skill sets, and when they have them, go on to international sites.”

Anjuli Jindal, M.D., began working at the clinic as a PGY-3 in 2007 and has served as a consultant for four hours a week since 2009. She evaluates immigrants and people seeking asylum in the United States and also supervises GW residents.

“You feel the world is so much bigger than your own small community,” she said. “I continued here because I felt this was so important, so needed.”

In addition to the tales of the difficulties in adjusting to a new country or the graphic stories of trauma in their home countries experienced by refugees, Jindal has heard and is heartened by her patients’ resilience and recovery.

“It restores your faith in kindness and the human connection.”

Fourth-year residents can elect to work on a mental health program overseas or a general medical project in another country as a team psychiatrist.

In recent years, GW residents have participated in global mental health research, training, or human-rights projects in Liberia, Uganda, South Africa, Greece, the West Bank, Cambodia, Nepal, and India, said Griffith.

Psychiatrist and anthropologist Brandon Kohrt, M.D., Ph.D., has applied lessons from his George Washington University residency to his work in Mongolia, Nepal, and Liberia.Photo Credit: American Psychiatric Association/Aaron Levin

Brandon Kohrt, M.D., Ph.D., finished his residency in 2013 and is now an assistant professor of psychiatry at Duke University and a member of the Duke Global Health Institute in Durham, N.C. He values the time spent in the North-ern Virginia clinic.

Both Morse and Kohrt developed their overseas connections before they arrived at GW.

Kohrt’s doctorate is in anthropology. Even before he came to GW, he did extensive field work in Mongolia on a culturally specific syndrome analogous to chronic fatigue syndrome and with former child soldiers in Nepal. He helped produce documentary films on those topics in each country. He also worked as a consultant to an antistigma program in Liberia.

“I had an awareness of the context and needs of low-resource settings, but GW gave me the tools,” said Kohrt.

We’re busy here, actively preparing for the 2015 annual meeting which is less than five months away. Based on those all important evaluations that we’re always asked to complete, we’ve modified the program structure a bit. Instead of keynote speakers, and in keeping with the global theme of the meeting, this year we will be having three plenary panels, one each day, on clinical and practice issues, funding issues and the role of non-government organizations (NGOs), and one on socio-cultural issues in global mental health.

We also will be introducing a number of interactive workshops. Some of the workshop topics include Cultural Adaptation of Psychotherapeutic Interventions, Design, Curriculum and Implementation of Training Programs in Global Mental Health, and Cross Cultural Instrument Development and Adaptation, to name just a few. And of course we will have our usual symposia. Please visit www.psychiatryandculture.org to view the entire program, register and book your hotel room. Early bird registration is open now. We have not raised the registration fees this year and, in fact, have reduced them for trainees. While you’re at the website, don’t forget to pay your dues for 2015. They are due by the end of January, but we’re happy to accept your money now if that works better for you.

The program format isn’t the only thing that’s changing. Administratively we’re shoring up a few things, too. Sticking with the annual meeting for another line or two, the number of participants in each workshop will be limited and pre-registration will be required. Reservations will be accepted on a first come, first served basis, a great incentive for registering early. This is a meeting you won’t want to miss. The program appears on Annual Meeting page.

Speaking of dues, we’re actually going to be sending out invoices for the first time this year. They will go to all current members as well as those who have belonged in the preceding two years but whose memberships have lapsed. Of course new members are always welcome at any time.

Many thanks to the member volunteers who are helping to make things happen on many fronts, especially the website re-development and mentorship program. Cheers to each and every one of you.

Finally, we’re planning to sell ads in our program book this year. If you would like to place one, please contact me for information on sizes and prices. And if anyone has suggestions about potential corporate sponsors, please don’t keep them a secret.

The rest of this newsletter is chock full of the many other activities that are going on within SSPC. There also is an article on Providence, a real sleeper city, for those of you who are unfamiliar with it, so I’ll sign off now with best wishes to each of you for happy and safe holidays and a healthy and happy new year.

Greetings everyone. It’s hard to believe that summer is half over and the 2014 Annual Meeting was two months ago. I hope everyone is having a good summer despite the weather.

In terms of numbers our meeting in San Diego was the best ever, with a total of 126 people registered. We now have104 paid members. Since the meeting Connie Cummings has designed a membership recruitment brochure which will be available to all of our members for distribution at meetings and wherever it might be helpful. It will be posted on the website soon and you can request a copy, which you can reproduce, from me.

Speaking of membership, we are implementing a new policy this year. Memberships are due for renewal no later than January 31 of each calendar year. In the past we have left it up to each individual to remember the deadline. Starting this year we will be emailing invoices to all current members early in December, thereby giving you the option of renewing in this tax year or next. We also will send bills with a different cover note to people who have belonged to SSPC in the past two years but have somehow forgotten to renew. This will make it easier for you and for us.

Plans for the Providence meeting, April 23-25, are proceeding nicely. Proposals for papers and workshops are due no later than September 15, so please check out the Call for Papers at our website, www.psychiatryandculture.org and see what you might want to contribute. You have been asking for more interactive participation at the meetings and we would like to provide it. Therefore, when you think about submitting a proposal, you might want to focus on developing a workshop instead of just giving a paper.

Please note that I will be off line from July 29 until August 7. I will try to check my email intermittently but, because I will be in the process of moving, my responses may not be timely and I will not have access to files. After August 5 my land line telephone number will be (484) 416-3915 and I no longer will have a dedicated fax number so you will need to call first if you want to send a fax. My email address will remain the same, ekramer931@gmail.com.

The theme of the annual meeting is Culture and Global Mental Health. We are particularly interested in submissions based on clinical activities, teaching, and research that address the relationship between cultural psychiatry and global mental health, including issues pertaining to mutual contributions, challenges, and collaborations. We also welcome papers, symposia, workshops, and posters in other clinical, education, and research areas of cultural psychiatry. The deadline for abstract submission is September 15, 2014. Abstracts should be submitted to PSYCHCULT2015@gmail.com. Potential speakers are urged to submit abstracts as soon as possible. Submissions should consider how their proposal fits with one of the five core areas and four cross-cutting issues highlighted for the 2015 Annual Meeting:

Origins and transformations of knowledge and practice
This core area examines issues of epistemology and ontology in cultural psychiatry and global mental health. How is knowledge generated, how are concepts defined, and which individuals and institutions have the power to define concepts in psychiatry and global mental health? What values influence and are reflected in global mental health priorities and practice? What roles and power do mental health service users, other persons living with mental illness, families, and communities have in influencing local and global mental health activities? How do epistemology, ontology, and value systems influence what is measured and counted through epidemiology and health economics? Ultimately, how does knowledge move between the local and the global?

Human rights, ethics, politics, and policy
This theme explores how ethical, political, and rights-based documents and doctrines influence the practice of psychiatry and global mental health. How do international policies, programs, and institutions (e.g., United Nations’ bodies, the World Health Organization, humanitarian organizations) frame human rights, and how is this reflected at local and national levels? How do ethical guidelines for clinical care, training, and research (or lack thereof) influence our practice?

Social determinants of mental health and health care
This theme traces how social and economic conditions and forces inform both mental health problems and mental health services. How do globalization, poverty, international development, health industry priorities, and political economy inform both problems and solutions in driving mental health problems and mental health practice?

Intervention development and cultural adaptation
How are interventions selected, developed, and tested in psychiatry and global mental health? What constitutes an evidence base for selecting interventions? What is the process for cultural adaptation, and how are cultural adaptations unique (or not) compared to other types of adaptations? How do indigenous or local interventions, systems of medicine, and sources of resilience fit with the aims of psychiatry and global mental health?

Scaling-up, implementation, and knowledge dissemination
How do interventions and practices go from proof-of-concept to large-scale implementation? What and who are the powers that determine worthiness for scaling-up and what benchmarks do they use? How is care implemented in a collaborative framework with other stakeholders ranging from primary care workers to partnerships with advocacy groups, mental health service users, families, and communities? How do objectives of cultural specificity and scalability impact one another?

In addition, there are cross-cutting issues that may play a part in each of the above:

Knowledge transfer between and among low- and middle-income countries (LMIC) and high-income countries (HIC)
How are knowledge and lessons learned transferred from high to low-resource settings and vice-versa? How is knowledge transferred among low-resource settings, e.g. South-South collaborations?

Stigma
Stigma influences activities and programs from the level of clinician-patient interactions to policy-making and implementation.

Populations and predicaments
For each of the areas, the specific populations should be defined. For example, are program beneficiaries defined by specific disorders, risk factors, or other context or health-related factors?

Submissions with qualitative and quantitative primary data and clinical encounters will be given preference over position pieces. The goal of the conference is to advance dialogue in cultural psychiatry and global mental health that is grounded in firsthand experience with research, teaching, clinical activities, public health interventions, policy- making, and other activities.

As a guideline, designated keynote presentations will be 40 minutes long, followed by 20 minutes of discussion, for a total of one hour. Individual papers and symposia consisting of 3 presentations will be 2 hours long, with 30 minutes for each presentation plus 30 minutes for discussion of all the papers. In all cases 25% of the time must be allocated for discussion. This is an ACCME requirement as well as a request from many of the attendees of the 2014 meeting. In response to your evaluations of this year’s annual meeting we are very interested in receiving proposals for interactive workshops, especially in areas where skill building or attitude modification are key.

Instructions for Authors

All proposals must include the information below:

1. Identifying information (name, affiliation, contact information) of all authors, with the presenting author so identified

2. Title of presentation

3. Abstract, composed of three parts

1-3 learning objectives

Narrative abstract, up to 200 words

1-3 related references

4. Classify your presentation by type, according to the following options:

Research

Education and Training

Clinical

Theoretical/conceptual

Policy

5. Indicate whether your abstract is a general submission or whether it focuses on Culture and Global Mental Health and which of the five areas it addresses.

6. For an organized symposium, there should be one joint submission that includes (a) the organizer’s identifying information, (b) the symposium title, (c) the symposium abstract (including text, learning objectives, and related references), and (d) the information for each paper within the symposium (presenter, title, abstract).

7. Please indicate whether your submission is for a poster only or whether you would like it to be considered for presentation as a poster if we are unable to accept it as a paper.

8. You will need to complete a disclosure form and return it with your abstract. The form is available at the SSPC website https://psychiatryandculture.org/. If you need assistance in obtaining a disclosure form, please contact ekramer931@gmail.com.

9. Finally, if you are a trainee submitting a paper for consideration for the Charles Hughes Social Sciences Trainee Fellowship or John Spiegel Clinical Sciences Trainee Fellowship, please see the separate call for Fellowships on
the SSPC website or contact brandon.kohrt@duke.edu.

Submit all materials to PSYCHCULT2015@gmail.com. Submissions should be in a Microsoft Word document or comparable file type format. Files should be labeled as follows:

Please make sure you use learning objectives, not teaching objectives. Teaching objectives state what you are trying to teach. Learning objectives are what you expect the attendee to know or be able to do after attending your presentation.

The objectives must use action verbs, which allow for the measurement of quantifiable outcomes. For example, At the conclusion of this presentation learners will be able to:

1. define what an action verb is and list three characteristics of it 2. describe two reasons why educational objectives are important 3. discuss the importance of action verbs in preparing measurable educational objectives.

An excellent reference for this task is Robert Major’s, Preparing Instructional Objectives, 3rd edition, available from Amazon.com if not at your local library.

All individual papers must contain 2 or 3 learning objectives. Each paper that is part of an organized symposium must contain 1 or 2 objectives and the moderator should prepare 2 or 3 objectives for the entire symposium. All presentations in a symposium or workshop must be submitted together by the organizer.

Narrative Abstract

Abstracts should be structured, and they should NOT exceed 200 words, excluding the objectives and references. Guidelines for preparing structured abstracts, though slightly more detailed than we require, can be found in the Archives of General Psychiatry’s Instructions to Authors section on preparing structured abstracts.

Abstracts for submissions classified as Research will include the following subsections: (1) Background, (2) Aims/Objectives, (3) Methods, (4) Results, and (5) Conclusion.

Abstracts for submissions classified as Education and Training, Clinical, Theoretical/ Conceptual, or Policy will include the following subsections: (1) Background, (2) Aims/ Objectives, (3) Proposition and Discussion, and (5) Implications.

For general member paper submissions only:

Each proposal must include at least one reference. References should be listed in the field labelled references. Do not include references in the body of your abstract.

All abstracts should be written in English and be of scholarly quality. Type size should be 11 or 12 point, and the font should be simple and clear. Our preferred font is Arial. Please do not format your abstract or use fancy fonts. Proposals will be screened prior to being sent out for peer review. Those that are found to be out of compliance with these guidelines will be returned to their authors for revisions and corrections. Authors will be given 10 days to make corrections and re-submit without penalty. However, no extensions for final submission will be permitted.

Disclosure Form

Please note that proposals will not be reviewed without your completed disclosure form, which is available at the SSPC website, here.

If you have any questions, please contact Roberto Lewis-Fernández, Chair of the Program Committee, at rlewis@nyspi.columbia.edu, or Liz Kramer, Executive Director, at ekramer931@gmail.com, or call her at (484) 496-3915 after August 5.

Our Mission

The Society for the Study of Psychiatry and Culture (SSPC) is a nonprofit, interdisciplinary organization devoted to furthering research, clinical care and education in cultural aspects of mental health and illness.
We aim to promote cultural psychiatry in North American professional groups and to collaborate with national and international organizations in the development of policy and practice. Primarily rooted in North America, we provide an interface for domestic and international interests of cultural psychiatry and mental health.
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